Open Letter to Patients, Physicians, and Lawmakers

This is the first letter I’ve ever written to a political figure and I pray that someone on your staff will bring this letter to your attention. I have been a physician for close to 30 years. I am a second-generation pediatrician struggling to keep an independent solo practice alive. Not one politician has addressed what I feel is the major threat to health care…the physician-patient relationship. Without this, there is no quality of care no matter what you do. Physician patient relationships require time with the patient.

Most of my diagnosis is derived from my patient-parent interview and a “hands on exam” of the child. You cannot possibly read a cookbook of medical questions and treatments and have the same result. The current insurance treadmill model of primary care makes this impossible. There is a hemorrhaging exodus of well-trained physicians unwilling to jeopardize this patient relationship. Insurance companies are pushing the small man (or woman), like myself, out and replacing us with cheaper, less qualified “health care extenders” i.e. nurse practitioners, physician’s assistants, pharmacists, or whomever they can place in a white coat for less money. This is at the expense of the patient and the profit of the insurance company.

I have done everything by the book. During my 12 years of postgraduate training I earned a degree in chemistry and biology, a Masters degree in Microbiology, and MD degree from Georgetown University Medical School where I also completed my pediatric residency. I am board-certified and recertified. I have a spotless record and a loyal patient following. I am not saying this to fluff my feathers but to emphasize my dedication to my calling. It is not just a job to me. This is what I was meant to do, and I will only do it the correct way.

Coming from generations of physicians, I take my job very seriously. My father was also a pediatrician and started his office in the basement of our home. I know what quality care is, and what it is not. I grew up knowing that medicine can exist without the interference of insurance companies. At that time, people paid a fair price for an office visit and had catastrophic hospital coverage for hospitalization and procedures. (My father actually was the physician who saved John F. Kennedy’s son, John John. His name is Dr. Ira Seiler M.D. It is a true story accessible through the archives. He also attended John F. Kennedy’s inaugural ball and parade).

My father instilled in me a respect for the patient-physician relationship without which there is no quality care. Insurance companies have continued to decrease our payments knowing that we will need to see more patients in a shorter amount of time to make up for the decreasing reimbursement rates. You do not have time to foster a relationship. This may result in more medical mistakes but ultimately bring in more money to the pockets of the insurance company. This is a very dangerous game, and I have refused to play it. For that I have been threatened and penalized.

I am trying desperately to keep my small practice alive. I spend at least 30 minutes with each patient, they have access to me via my personal cell phone 24/7. I have no wait times, will always see a sick patient that day, try to avoid ER/Urgent Care visits by seeing the patient after hours myself ( to avoid medical mistakes since after hours clinics usually are not staffed by pediatricians and I end up correcting the mistakes at 3am for free anyway). Many times I’ll bring a chart home and research a condition and if I don’t know something I will find out. And for this I am listed as a physician that is not cost effective, or in other words I spend too much time per patient, which results in less revenue to the insurance company.

Medicine is not a 9-to-5 job, it is a calling and my greatest fear is that no one is going to want to do this job for a salary of $6000 a year, which after all my office expenses, I earned. And that is not from poor business skills or lack of patients. It is from decreasing reimbursement rates and higher overhead. This is why most physicians have left private practice to join hospital settings or larger groups. Many people don’t know that I have to pay not one but two malpractice payments in the state of Pennsylvania, licensing and board fees, rising medical and office supply fees which total @ 15,000 a month. I have one nurse, a receptionist, myself and one part-time relief doctor who is amazing, having trained at both Duke and Northwestern. I have not taken a paycheck in 8 months.

I continue to do this job because that’s what I was meant to do and I don’t want to give up on my patients. I should not be subject to prejudice for practicing good medicine. I am scared who will take care of these children or my family when those like me are finally forced out completely.

I am not a “healthcare provider”. I am a physician and there is a very big difference. I hope that you will think about this in your fight to fixthe problems in healthcare, because it’s more than just repealing Obamacare. It is putting medicine back into the hands of the patient, consumer, and the physician. Insurance companies are for profit companies, parasitizing my expertise and exploiting your savings. If they are getting paid for my expertise and training, maybe the CEO’s of these insurance companies should try doing the surgeries and treating the patients themselves.

Drop the worst paying insurance company and explain why to your patients. Repeat until you are insurance free. The patients who value your skill and expertise will stay with you, and you cannot do worse than you are doing now. You are a great doctor and need to be respected as such. Don’t quit now. Thanks for sharing your story.

Agree with the last comment. You are a fantastic doctor and cannot be selling yourself short. Look into dropping all 3rd party payors, drop Medicaid, and your happiness will soar, set reasonable fees and go direct pay. Most patients have such high deductibles today that they must pay cash anyway to see a doctor. And after they go to the “QuickCare” and see the “provider” they get misdiagnosed and mis-prescribed and they come back to one who knows what she’s doing. I see this all the time as a dermatologist, because today everyone thinks they’re a dermatologist too–LOL.
Government cannot fix this mess. They only way would be for them to get out of the way completely–repeal Obamacare and let the free market back into medicine. The way it is now, it’s a catastrophe, for patients, for doctors, for the economy, for businesses.
Unfortunately you may have to let some staff go, if you earn less, but you’ll have less overhead to eat you alive. As a fellow physician, I am upset as you are but dangerous times call for drastic action. Look into a less expensive office situation, and set yourself free.

For similar reasons I chose a concierge type of practice model.After 8 years I am professionally happy and enjoy my patients and the time available to research cases,speak to specialists and cut through the red tape of insurence companies.It may not be for everyone but beats burning out as many of my colleagues have done.

I agree with so many physicians comment here- we have been made to work like robot- ” all diseases have to follow a protocol” and not go by individual patient. We are forced to follow insurance company’s PQRS and other criteria and if we achieve good score on it ( does not matter if patients are treated right or not), we become “great doctor”.

Unfortunately, this critical situation is shared by many in private practice. Some have chosen the concierge route, many have “dropped out” of practice; leaving medicine altogether or electing to be employees. The bottom line is that the current healthcare system has become the poster child for efforts at social engineering by promoting failed policies and faulty economics. I have seen the changes and erosion in the system for over thirty years in healthcare as a neuropsychologist.
The result, fractured doctor-patient relationships and governmental controls (sounds like EMRs?) under the guise of “quality control”.
This is one of the many reasons why I have chosen to run for Congress in the PA8th district (Bucks County). I would vote to repeal Obamacare, and replace it with common sense legislation that promotes a return to quality doctor-patient care.
Read more about me at duomeforcongress.com

Hello, Dr. Sharon.
You can’t do it alone and physicians, even if organized and united, can’t do it alone. The medical profession has drifted away from our mission and power base … Patients and Best Patient Care and Treatment. The mistake I made in my first 30 years of practice was to work FOR the patients. During the last decade, I realized we have to work WITH the patients to fix the Business of Medicine problems, because the patients have the power.

Working with a coalition of the willing people-patientsphysicians-providers to create alternatives to The Business of Medicine @ Veritas Health Care, the non profit http://www.veritasHC.org.

I don’t understand why you you are allowing insurance companies to dictate how you run your practice. Wouldn’t it be easier to limit the insurance you accept to those companies that pay a reasonable fee for an office visit, or have patients pay the fee you believe you deserve? Why would you want a client base who doesn’t value your services enough to compensate you fairly?

Pediatricians often feel we “have to” take Medicaid and poor paying insurance. Stephen Covey told us that effective people never say “I have to.” We do need to join with colleagues though. AAPS is having a seminar on May 20 about going Galt from the CMS and Big Insurance. Another group worth joining and supporting the physician is the American College of Pediatricians. Let’s put the physician-patient relationship first. Trust in God. Do you think He will not help the children? There are Christian medical coops for people that follow Christian morals that will cover families. Don’t listen to the Author of Despair.

Sharon, I just read your letter now and am once again proud to be a pediatrician because of my colleagues like you. I don’t have an easy answer for you. I recently moved from private practice to community health work. In every practice experience I’ve had in 4 different states over two decades, I’ve absolutely loved the patients and led a life similar to yours.

Families don’t usually have the choice to go to a pediatrician who does not accept insurance so I’m not sure that is the answer. I do think that there are other physicians who are like you because I am. If my husband weren’t doing exactly what you are doing except in a solo general surgery practice in another Northeastern state, I would move down to PA tomorrow and join you in your practice and with you find ways to keep doing what you love but get a reasonable monthly paycheck. Perhaps you could find like minded quality oriented physicians who could band together to reduce overhead while practicing the way we all should be practicing?

I’ve made some stands lately to allow myself to keep putting my patients first. They won’t last forever but I am in pediatrics for the patient-physician relationship and when that goes, I’m gone too. We are all in this together.

I think I’m ready to write a letter to the editor … and a bunch of politicians … myself. Maybe we ALL should! Keep up the good fight!

I am an ENT Doc with almost 30 years experience also and the same financial events happened to me in Vermont , I was the last private practice ENT and had to join our hospital in order to keep the ENT services available for our community. There is no question it now costs the system more money than before.

Enjoyed your letter. I agree with it completely. I am one of those pharmacists that are getting shoved into being a ‘healthcare extender.’ Right now I am forced to give immunizations even though I don’t necessarily feel comfortable with them, luckily it is only for 9 and older, I wouldn’t want to be giving them to anyone younger without more than a multiple hour CE course. Soon we as pharmacists will be prescribing medications after we receive a diagnosis from the practitioner, to promote cost savings. I can only say, good thing I am on the downward slope of my career.

Outstanding letter. Unfortunately, I doubt many legislators/bureaucrats will read or understand. Things like this drove me out of the “normal” practice of medicine. I now do some work in my private office (cash only….but cheap…just me and my receptionist/assistant); and some work completely outside medicine.